POSITIVE: See Research Design and Implementation Criteria Checklist below.

Research Purpose:

To determine how dietary patterns, self esteem, depressive symptoms, and intention to lose weight were associated with body size among African American Adolescent mothers 1 year after delivery and with changes in body size over the next year.

Inclusion Criteria:

African-American Mothers

Participants in a longitudinal randomized controlled trial of a home intervention program to promote parenting and adolescent development among low income families.

Mothers with infants with congenital problems, chronic illness or disabilities.

Description of Study Protocol:

Recruitment : Recruited participants of home intervention trial from 3 urban hospitals, shortly after delivery. Study was explained and eligible, interested mothers were given an appointment to obtain baseline data, further determine eligibility, and obtain consent.

Design: Cross sectional study and trend analysis

Blinding used (if applicable): N/A

Intervention (if applicable): N/A

Statistical Analysis:

Covariates in all analyses: intervention status, maternal age at delivery, education and breastfeeding history

caloric intake included both in and out of models: no differences so results presented without adjusting for energy intake

Other relevant demographics: 66% in high school, 68% unemployrd, 92% single (51% in a relationship)

Anthropometrics :

Under/Normal weight: 51 (43%)

At risk for overweight: 28 (24%)

overweight: 39 (33%)

Location: United States

Summary of Results:

Key Findings

One year after delivery, 33.0% of mothers were overweight (BMI> 95th percentile) and 23.7% were at risk for overweight (BMI > 85th percentile and < 95th percentile).

Mothers consumed a daily average of 2,527 kcal and 4.1 high-fat snacks.

A total of 11% of normal-weight mothers, 22% of mothers at-risk for overweight, and 44% of overweight mothers reported intention to lose weight (chi-square=10.8, P<0.01). However in multivariate analysis, there were no differences in any of the variables (dietary patterns, self-esteem, or depressive symptoms) by the mothers' intentions to lose weight.

Dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were not realted to body size or increase in body size.

Variables

Under/Normal weight

at risk for overweight

overweight

Dietary patterns (servings in 6 categories, Kcal/kg/d)

Mean, SD

2587, 1184 kcal/kg/d

Mean, SD

2405, 1253 kcal/kg/d

Mean, SD.

2549, 1083 kcal/kg/d

no significant difference

Self esteem

32.7, 5.1

33.9, 4.6

32.7, 4.3

no significant difference

Depressive symptoms

7.8, 11.1

7.4, 8.3

6.1, 8.8

no significant difference

Intent to lose weight (%yes)

10.9

22.2

43.8

p=0.01

Other Findings:

average change in BMI z score was 0.13+0.53. Most mothers, hoever remained in the same BMI cateory (76%). Approximately 16% moved upa category and 8% moved down a category.

Author Conclusion:

Authors conclude that "Programs that emphasize weight loss or thinness may have limited usefullness among African American adolescents, who may not conceptualize overweight in negative terms". They further suggest that attention should be focused on multilevel public health interventions, including alternatives to high fat snacks. In the abstract, authors conclusions include: overweight was a common problem in adolescent African American mothers and increased over time, and may benefit from strategies to identify alternatives to high fat snack food.

Reviewer Comments:

Limitations include self reporting, accuracy of food frequency records to assess intake, physical activity not considred, and high attrition rate. Additional concerns include that although eligibility required participants living with an adult guardian, not all subjects complied, and there was no information on which of the subjects were in the intervention group (was there an equal distribution)

Research Design and Implementation Criteria Checklist: Primary Research

Relevance Questions

1.

Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)

Yes

2.

Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?

Yes

3.

Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?

Yes

4.

Is the intervention or procedure feasible? (NA for some epidemiological studies)

N/A

Validity Questions

1.

Was the research question clearly stated?

Yes

1.1.

Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?

Yes

1.2.

Was (were) the outcome(s) [dependent variable(s)] clearly indicated?

Yes

1.3.

Were the target population and setting specified?

Yes

2.

Was the selection of study subjects/patients free from bias?

Yes

2.1.

Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?

Yes

2.2.

Were criteria applied equally to all study groups?

Yes

2.3.

Were health, demographics, and other characteristics of subjects described?

Yes

2.4.

Were the subjects/patients a representative sample of the relevant population?

No

3.

Were study groups comparable?

Yes

3.1.

Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)

Yes

3.2.

Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?

If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?

Yes

3.5.

If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)

Yes

3.6.

If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?

N/A

4.

Was method of handling withdrawals described?

Yes

4.1.

Were follow-up methods described and the same for all groups?

Yes

4.2.

Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)

Yes

4.3.

Were all enrolled subjects/patients (in the original sample) accounted for?

Yes

4.4.

Were reasons for withdrawals similar across groups?

???

4.5.

If diagnostic test, was decision to perform reference test not dependent on results of test under study?

N/A

5.

Was blinding used to prevent introduction of bias?

Yes

5.1.

In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?

N/A

5.2.

Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)

N/A

5.3.

In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?

Yes

5.4.

In case control study, was case definition explicit and case ascertainment not influenced by exposure status?

N/A

5.5.

In diagnostic study, were test results blinded to patient history and other test results?

N/A

6.

Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were intervening factors described?

Yes

6.1.

In RCT or other intervention trial, were protocols described for all regimens studied?

N/A

6.2.

In observational study, were interventions, study settings, and clinicians/provider described?

Yes

6.3.

Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?

Yes

6.4.

Was the amount of exposure and, if relevant, subject/patient compliance measured?